Provider Demographics
NPI:1518621432
Name:SAILLE, VINCENT A
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:A
Last Name:SAILLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:EL NIDO
Mailing Address - State:CA
Mailing Address - Zip Code:95317-0188
Mailing Address - Country:US
Mailing Address - Phone:559-936-5140
Mailing Address - Fax:
Practice Address - Street 1:48 ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:CHOWCHILLA
Practice Address - State:CA
Practice Address - Zip Code:93610-2928
Practice Address - Country:US
Practice Address - Phone:559-665-1096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH94251183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician